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Orthostatic hearing loss: audiovestibular manifestations of spontaneous intracranial hypotension
  1. Frederick Schon1,
  2. Arun Karunakaran2,
  3. Sarah Shanmuganathan3,
  4. Arani Nitkunan1
  1. 1 Department of Neurology, Croydon University Hospital, Croydon, UK
  2. 2 Department of Audiology, Croydon University Hospital, Croydon, UK
  3. 3 University of Glasgow, Glasgow, UK
  1. Correspondence to Arani Nitkunan, Department of Neurology, Croydon University Hospital, Mayday Road, Croydon CR7 7YE, UK; anitkunan{at}


A 36-year-old woman with severe postural headaches caused by spontaneous intracranial hypotension developed bilateral hearing loss. Her hearing loss varied in severity and also at times affected one ear more than the other. She noticed her hearing returned to normal on lying flat, and this was confirmed on audiometry. Her hearing fully recovered after treatment with blood patches. Audiovestibular symptoms affect up to 70% of people with spontaneous intracranial hypotension but are probably under-reported. Cerebrospinal fluid and inner ear fluids are related in two separate channels: the vestibular and the cochlear aqueducts. We discuss their role in the postural hearing loss of spontaneous intracranial hypotension.


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  • Twitter Arani Nitkunan @anitkunan.

  • Acknowledgements We thank Dr Declan Johnson with his help on the neuroradiology, Professor Tim Griffiths for his helpful comments on our manuscript and Miss Gauthami Vireswer for help with figure 4.

  • Contributors FS and SS wrote the first draft. AK contributed to the audiogram images. AN and AK helped with revision of the drafts.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Consent obtained directly from patient(s).

  • Provenance and peer review Not commissioned. Externally peer reviewed by Michael Halmagyi, Sydney, Australia.

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  • Editors’ commentary
    Phil E M Smith Geraint N Fuller

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